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Clinical Prep > Diabetes Meds > Flashcards

Diabetes Meds Flashcards

1
Q

1st line tx for DM II

A

Metformin

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2
Q

Metformin mechanism

A

decrease Liver production of glucose (no effect on beta cells)

Added benefits:

  • weight loss
  • decrease triglycerides
  • dec CVD risk
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3
Q

SE of GI complaints, metallic taste, Vit B12 def, Lactic acidosis

A

Metformin

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4
Q

Sulfa meds

A

“Gl____”

2nd gen (used more often)

  • Glyburide
  • Glipizide
  • Glimepiride

1st gen

  • Tolbutamide
  • Chlorpropamide
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5
Q

Mechanism of sulfa

A

Stimulate beta cell Insulin release

similar glycemic efficacy as Metformin

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6
Q

SE of Sulfa

A

HYPOGLYCEMIA risk

Weight gain

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7
Q

Chlorpropamide (a 1st gen Sulfa med) has unique SE

A

Hyponatremia (low sodium)

Disulfuram like rxn (do not drink alcohol)

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8
Q

Meglitinides

A

“___glinide”
Repaglinide
Nateglinide

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9
Q

Repaglinide
Nateglinide

mechanism

A

Stimulate beta cell Insulin release

more so post prandial

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10
Q

SE of Metiglinides are same as sulfa

A

Hypoglycemia

Weight gain

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11
Q

Repaglinide is a good option for

A

pts with CKD

nice to the Kidneys

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12
Q

TZDs

A

Pioglitazone
Rosiglitazone

increase Insulin sensitivity at PERIPHERAL sites

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13
Q

SE of TZD

A

EDEMA
Fluid retention
BAD for CHF
Increased fractures

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14
Q

do NOT use TZD with

A 
Type I DM
HF
Hx bladder CA
High risk fractures
Pregnancy
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15
Q

DPP-4 inhib

A

“gliptins”

Sitagliptin
Linagliptin
Saxagliptin

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16
Q

Sitagliptin
Linagliptin
Saxagliptin

are all

A

DPP-4

“gliptins”

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17
Q

Mechanism of “gliptins” (DPP-4 inhibitors)

A

Slow degradation of GLP-1 allowing that enzyme to do its job

leading to: increased Insulin sens, dec Glucagon secretion, decrease gastric emptying

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18
Q

SE of “gliptins” (DPP-4inibitors)

A 
Acute Pancreatitis
HA
Hepatitis
Skin change
Joint pain
Renal dysfx
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19
Q

Saxagliptin has a bad rep for being linked to

A

increased risk of HF (heart failure)

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20
Q

GLP-1 RA

A

Liraglutide
Exanatide
Dulaglutide

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21
Q

Lira
Exana
Dula

A

GLP-1 RA

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22
Q

Mechanism of GLP-1 RA

A

Mimics Incretin

  • increase Insulin sensitivity
  • decrease Glucagon release
  • delay gastric emptying

Added benefits

  • weight loss
  • decrease CVD events
  • no risk of Hypoglycemia if used alone
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23
Q

CONTRA to GLP-1RA

Lira
Exana
Dula

A

Hx of Gastroparesis
Hx of Pancreatitis
Hx of THYROID CA
Hx of MEN syndrome

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24
Q

SGLT-2 Inhibitors

A

“flozins”

Empagaflozin
Canagliflozin
Dapagiflozin

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25
Q

SGLT-2 Inhibitors

A

Proximal tubule

Increase glucose excretion
weak when used alone, thus often used in COMBO with: Pioglitazone, Sitagliptin, or Insulin

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26
Q

Benefit of SGLT-2 Inhibitors

A

Decrease CVD events
Lower BP
Weight loss

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27
Q

CONTRA to using SGLT “flozins”

A

Type I DM

or Type II DM if GFR <60 (need a good working kidney to use these)

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28
Q

Canagliflozin has a bad rep for being linked to

A

Amputation risk!!!

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29
Q

Caution in using SGLT2 inh “flozins” with other meds that can cause Dehydration

A

NSAIDs
ACE-I
ARBs
Diuretics

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30
Q

SE of SGLT 2 Inhib “flozins”

A 
N/v
Thirst
AKI (acute kidney injury)
Bone fracture
UTI
Yeast infection
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31
Q

Acarbose

Miglitol

A

Alpha glucosidase inhibitors

delay intestinal glucose absorption
less potent than Metformin and Sulfa

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32
Q

a-glucosidase inhibitors

  • Acarbose
  • Miglitol

SE

A

GI, flatulence, diarrhea, Hepatitis

safe in pts with Kidney issues

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33
Q

Two best meds for MACE prevention

A

Empagaflozin (SGLT)

Liraglutide (GLP)

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34
Q

Lispro

Aspart

A

Rapid acting insulin

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35
Q

Lispro, AKA

A

HUmalog

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36
Q

Aspart, AKA

A

Novolog

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37
Q

NPH

Lente

A

Intermediate insulin

38
Q

Detemir

Glargine

A

Long acting insulin

39
Q

Decrease Cardiovascular events

A

Liraglutide

Empagaflozin

40
Q

Linked to amputation

A

Canagaflozin

41
Q

Linked to Heart Failure

A

Saxagliptin

42
Q

Nice to kidneys

A

Acarbose, Miglitol

Repaglinide

43
Q

Weight loss

A

GLP-RA “glutides”
Metformin
SLGT “flozins”

44
Q

Weight loss

A

Metformin
Empagaflozin, Canagaflozin, Dapagaflozin
Liraglutide, Exanatide, Dulaglutide

45
Q

“glutides” and “flozins” and Metformin are special why:

A

Aid in Weight loss

46
Q

Aspart “Novolog” and Lispro “Humalog”

A

Fast acting insulin

47
Q

Detemir and Glargine

A

Long acting insulin

48
Q

Glyburide, Glipizide, Glimepiride

A

Sulfa diabetes drugs

49
Q

Bactrim

A

is a SULFA drug

Trimethoprim/Sulfamethoxazole

50
Q

What do you need to avoid if pt has Sulfa allergy?

Med names that may be sneaky

A

Bactrim
Glyburide
Glipizide
Glimepiride

51
Q

Diagnosing Diabetes

all symbols are Greater than or Equal to

A

Fasting 126
A1C 6.5%
2 hour test 200

Classic sx + Random 200

52
Q

Diagnose DM with FASTING glucose

A

126

53
Q

Diagnose DM with A1C

A

6.5%

54
Q

Diagnose DM with Random glucose

A

200 + need Classic sx of Hyperglycemia

55
Q

Diagnose DM with 2 hour test

A

200

56
Q

If ASCVD risk is >20%

A

Need High intensity Statin therapy

57
Q

Why are Diabetes and ASCVD together so important to keep an eye on?

A

Those with Diabetes are 2x as likely to die of STROKE or HEART ATTACK than those w/o

58
Q

MACE

A

Major Adverse Cardiovascular Event

59
Q

Meds that help prevent MACE

A

Flozins (SLGT)

Glutides (GLP-RA)

60
Q

If pt has ASCVD (Atherosclerotic Cardiovascular Dz)
AND
Diabetes, what should the be on other than the Diabetes meds?

A

ASA (anti-clot)

Statin

61
Q

Weight loss

A

Glutides

Flozins

62
Q

Safe for HF or CKD

A

Flozins

63
Q

If pt needs a cheap Med

A

TZD

Sulfas (Glyburide, Glipizide, Glimebiride)

64
Q

What to reach for first in DMII meds?

A

Metformin
Glutides (GLPra)
Flozins (SLGT)

65
Q

DM II meds that you generally avoid d/t SE unless pt needs cheap med

A

Sulfa (Glyburide, Glipizide, Glimepiride)

TZD (Pioglitazone, Rosiglitazone)

66
Q

TZD risky business

A

Edema, fluid retention
CHF
Inc fractures
Dangerous w Type 1 DM, Bladder CA, High risk fx, Prego

67
Q

Good choice for Dual therapy in DM mgmt

A

Metformin +

Glutide (GLPra)
Flozin (SGLT)
Gliptin (DPP)

68
Q

1st picks after Metformin

A

Glutides

Flozins

69
Q

Glutides and Flozins are 1st picks after Metformin, but what do we need to be aware of with Glutides (GLPra)?

A

Glutides are a/w increased risk of Thyroid C-cell Tumor Risk

70
Q

Thyroid C cell tumor risk

A

Glutides

Liraglutide, Exanatide, Dulaglutide

71
Q

With Flozins, what do you need to keep in mind?

A

Making the kidney tubules work harder by excreting more and more glucose

MONITOR GFR!!!
Have to stop if GFR drops below 30

72
Q

Flozins (SGLT) have a FDA warning for

A

Quiet DKA

73
Q

Canagaflozin (SGLT) is a/w

A

INCREASED AMPUTATION RISK

esp if pt has DM and ASCVD

74
Q

Eventually, someone with Type II DM might have to start using Insulin if other meds aren’t working

if these values are reached or exceeded

A

A1C 10%

Glucose 300

75
Q

Insulin Glargine, aka

A

Lantus

long acting

76
Q

Insulin Detemir and Degludec are

A

Long acting

77
Q

Insulin NPH, aka

A

Humilin N
Novolin N

Intermediate acting

78
Q

Long acting insulin timeline

A

reaches blood several hours later, but works for 24 hours

79
Q

Intmdt acting insulin

NPH, Humilin, Novilin

A

Starts working 2-4 hours later, peaks 4-12, then stops working 12-18 hours later

80
Q

Regular/SHORT acting insulin

A

Reaches blood in 30 min
Peaks 2-3 hrs later
Works for 3-6 hours

81
Q

TImeline for Regular/SHORT acting insulin that is used often

A

Reach 30 min
Peak 2-3 hr
Last 3-6 hrs

82
Q

Regular/short acting is DIFFERENT from

A

RAPID acting

83
Q

Rapid acting insulin, aka

A

“mealtime”

“Correction”

84
Q

Rapid acting insulin is used often
“meal tie”
correction”

A

Lispro (humalog)
Aspart (novolog)
Glulisine (apidra)

85
Q

Lispro, aka

A

Humalog

Rapid acting

86
Q

Aspart, aka

A

Novolog

Rapid acting

87
Q

Timeline for Rapid acting Insulin

Lispro “humalog”
Aspart “Novolog”

A

“mealtime”
“correction”

Starts working 15 min
Peak 1 hr
Continue working for 2-4 hours

88
Q

Good candidate for Premixed Insulin

A

If pt is stable on insulin and diet is same everyday

Poor adherence to basal-bolus regimen

89
Q

What is the risk with Premixed insulin

A

Hypoglycemia

90
Q

Calculating Basal dose

TDD= total daily dose

A

0.5 x 1 unit x Weight (kg)

91
Q

Insulin amount should be split between

A

Basal and Bolus

Clinical Prep (41 decks)

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